Effect of the women's health initiative on osteoporosis therapy and expenditure in Medicaid
Effect of the women's health initiative on osteoporosis therapy and expenditure in Medicaid
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DOI：
10.1359/jbmr.060119
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发表时间：
2006-05-01
影响因子：
6.2
通讯作者：
Choudhry, NK
中科院分区：
文献类型：
--
作者：
Udell, JA;Fischer, MA;Choudhry, NK
简介：激素替代疗法 (HRT) 已普遍用于绝经后妇女，但其使用正在减少，因为 2002 年 7 月妇女健康倡议 (WHI) 报告了不良心脏后果。WHI 对其他骨质疏松症药物使用和支出的相互影响尚不清楚。材料和方法：我们对 1995 年至 2004 年间 50 个州医疗补助计划的处方数据进行了时间序列分析。五种药物类别是使用：HRT、双磷酸盐、钙、降钙素和雷洛昔芬。结果：在 WHI 发布之前，HRT 不断增加，到 2002 年中期达到每年 500 万张处方（每 1000 名受益人有 136 张处方）。直到 2002 年中期，双膦酸盐处方量同时增加。 WHI 的发布与 HRT 使用的迅速减少有关，到 2004 年中期减少了 57%，达到每 1000 名受益人平均 59 个处方（p = 0.01）。随着处方速度的继续，WHI 的发布并没有增加双膦酸盐的近线性上升率 (p = 0.43)，而 HRT 却下降了。过去十年中，用于骨质疏松症治疗的医疗补助支出也发生了巨大变化，每 1000 名受益人的年支出从 1465 美元增加到 9742 美元，增长了 664%。在此期间，双膦酸盐也发生了从每日一次改为每周一次的显着转变。结论：自 WHI 发布以来，HRT 急剧下降，双膦酸盐处方持续增加。在此期间，医疗补助内的骨质疏松症药物支出也大幅增加。确定这些趋势对于骨质疏松症治疗是否具有临床意义和成本效益，将对未来药物报销计划的制定产生重要影响，特别是对于老年患者。
Introduction: Hormone replacement therapy (HRT) has been commonly prescribed to postmenopausal women, but its use is decreasing because adverse cardiac outcomes were reported by the Womens Health Initiative (WHI) in July 2002. The reciprocal impact of the WHI on other osteoporosis medications use and expenditure is unknown.Materials and Methods: We conducted a time series analysis on prescription data from 50 state Medicaid programs between 1995 and 2004. Five medication categories were used: HRT, bisphosphonates, calcium, calcitonin, and raloxifene.Results: HRT was increasing before publication of the WHI, reaching 5 million prescriptions per year by mid-2002 (136 prescriptions per 1000 beneficiaries). Bisphosphonate prescribing rose in parallel until mid-2002. WHI publication was associated with a rapid reduction in HRT use, declining 57% by mid-2004 to an average of 59 prescriptions per 1000 beneficiaries (p = 0.01). WHI publication did not augment bisphosphonates' nearly linear rate of rise (p = 0.43) as their prescribing pace continued, whereas HRT declined. Medicaid spending on osteoporosis therapy also changed dramatically during the last decade, as yearly expenditure increased 664% from $1465 to $9742 per 1000 beneficiaries. Over this period, a significant shift from daily to weekly bisphosphonates also occurred.Conclusions: A dramatic decline in HRT and continued rise in bisphosphonate prescribing has occurred since the publication of the WHI. During this time, there have also been substantial increases in osteoporosis medication spending within Medicaid. Determining whether these trends are clinically appropriate and cost effective for osteoporosis therapy will have important implications for the development of future drug reimbursement programs, especially for elderly patients.